Assessment of the tolerance to lupin-enriched pasta in peanut-allergic children

Background Reports of allergy to lupine derivatives (as de novo sensitization or crossreactivity in subjects allergic to peanut) are increasing as their use in food products increases. Objectives The aim of this study was to assess: (1) lupine tolerance in a group of children allergic to peanut, using lupine enriched-pasta instead of raw flour as has been done in previous clinical studies; (2) whether technological treatments of lupine modify its crossreactivity or co-sensitization with peanut; (3) the role of lupine seed proteins in sensitization, and (4) to identify the eliciting doses (EDs) by using double-blind, placebo-controlled food challenges (DBPCFC). Methods Twelve patients with a history of clinical allergic reactions to peanut were evaluated by skin prick tests (SPTs), the ImmunoCAPs test, immunoblotting, and DBPCFC. The 12 selected subjects were included in a trial where lupine-enriched pasta and placebo pasta were administered in a DBPCFC protocol. Results Positive clinical reactions were observed in two children, the EDs being 0.2 and 6.4 g of pasta, corresponding to 50mg and 1.6 g of lupine proteins, respectively. b-conglutin was the protein most involved in SPT positivity. Conclusion Lupine-enriched pasta can be tolerated by most subjects suffering from peanut allergy, but a sizeable minority (2/12 of them in this case) can develop potentially dangerous clinical reactions. Information about possible reactions to lupine derivatives by those allergic to peanutsmust be included in the labelling of lupine-enriched products to protect consumers at risk.